What would be the best long-term treatment for my hollow under eyes? (Photos)

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary fillers, micro-fat grafts, and blepharoplasties. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty including micro-fat grafts to the tear troughs will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

At least from the photo provided, it appears that the rolls under the eyes appear with smiling. If so, these "jelly rolls" can typically be easily treated via the use of two or three microdroplets of Botox placed into the "belly" of the muscle right below eye that is responsible for this. I have personally been performing this technique for this problem for over thirty years with gratifying results.
Jumping into surgery, especially when younger, is not without its significant expense, significant post-surgical downtime, and potential risks. So, heading straight for surgery, you might consider a consultation with an experienced, board certified cosmetic dermatologist.